‘Mind and Body: Part 2’
CAERS Substack Article #50
Sports psychologists understand that if an athlete can envision themselves being successful, they are more likely to be successful. Confidence plays a huge role in performance. Too much and we can become arrogant and sloppy; too little and we might sell ourselves short. The mind is a powerful thing.
The same can be seen in many aspects of life, including health care. Just as attitude and expectations are critical no matter the sport being undertaken, the same is true for any intervention involving health. The more positively a treatment is promoted, and the more confidence a patient has in it, the more likely it is to work. The probability of success may also relate to the seriousness of the condition being treated and the existence, or absence, of other effective treatments.
This can be true to the point where even something that could not possibly be therapeutic helps improve a patient’s condition. We refer to this as the placebo effect, from the Latin word ‘placere’, to please.
Unfortunately, the term placebo has received some bad press. Many interpret placebo as meaning that a patient has been purposely tricked, or they are so gullible or even dimwitted that a sham treatment works for them. In other words, they have not really improved; they just think they have. However, nothing could be farther from the truth.
I remember being told early in my career that ‘the doctor is the medicine’. In other words, a compassionate health care worker who listens respectfully to a patient and provides them with a sense of hope and meaning in their life will always be more successful in helping them than someone who does the opposite, irrespective of the treatment being offered. But how could that be?
Placebo does not simply mean that people convince themselves that they feel better, though that may be part of it. A far greater component of their improvement relates to the fact that their attitude, their mind, influences their body in a way that helps it heal. It is not purely a psychological effect: their blood pressure will actually go down, abnormal cells that could become cancerous are destroyed by a more invigorated immune system, and a broken ankle will heal better. As well, if someone believes that they are receiving a therapy that works, they may make other healthy lifestyle changes that contribute to their improvement.
It is common to hear of people who succumb to a disease shortly after they have given up hope for improvement or cure, or hear of individuals who will wait until family members have arrived for a final visit before allowing themselves to die. Some will even wait until family members have left the room to spare their loved ones the pain of seeing them take their last breath. Never underestimate the power of the mind.
So, no matter the nature of the treatment offered, some of the improvement will relate to the placebo effect, not to the treatment itself. Any time a health care worker wants to attribute 100% of a patient’s improvement to their therapy alone they are being dishonest with themselves (and with their patient).
Equally there exists the nocebo effect (from the Latin ‘nocere’, to harm), when a person will attribute adverse symptoms to a treatment when in fact there is no correlation or causation whatsoever. Imagine that I give you a chocolate bar made with the world’s best chocolate, and after you finish enjoying it, I tell you that the crunchy bits are not almonds as you assumed but roasted cockroaches. A significant percentage of people would start to feel a little nauseous and may even vomit or have diarrhea (I think I could easily be one of those people!). But that would likely stop the moment that they were convinced that their leg was being pulled and it really was almonds, not cockroaches, after all. That’s the nocebo effect, and like the placebo effect, it is very real. We experience adverse symptoms or deterioration because we believe that the intervention has harmed us even when it hasn’t.
It is partly because the body is so complex, and the mind-body relationship is also so complex and poorly understood, that we must study treatments very carefully for long periods of time to really understand them. It is why we use placebo control groups, why we blind both the researchers and the patients in the experiment, and why we allocate volunteers randomly to the treatment group or control group (who get placebos or some other treatment). And only when the study has a sufficient number of participants can we have enough data to identify how many of both the good and bad outcomes truly relate to the treatment being studied, not to the placebo and nocebo effects. And in many studies, both of those effects can contribute significantly.
We should not be surprised or embarrassed by either of these phenomena—placebo and nocebo. Rather, we should both marvel at their existence and find ways to utilize the power of the mind to help us to heal using the bodily mechanisms that all of us already possess.
With the amount of stress that each of us have been under during the pandemic, we would be wise to focus some time and energy on how we can use our minds to heal ourselves of any harm that we may have experienced. Like high-level athletes, our attitude will play a huge role in our success.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator
Thank you! I’ve been saying that for decades, we should marvel at the placebo effect and develop huge research on it! Stop ridiculing it, it is a source of tremendous empowerment and sanity (given the distortions being paraded in the pharmaco-medical industry). I am so glad that you received the wisdom of « the doctor is the treatment ». I wish that was a second tenet of medical ethics: 1) do no harm ; 2) always remember you are a BIG part of the treatment (and thus a whole course - yearlong perhaps - on supportive bedside behaviours and skills and attitudes, as well as a whole course on self care for MDs!